Study: Residents' preferences found to be misaligned with life-sustaining directives

Skilled nursing facility residents' current treatment preferences don't always agree with forms detailing their preferences for life-sustaining medical orders, results of a study published Tuesday suggest.

A team of researchers from Indiana University and the University of California-San Francisco examined the use of Physician Orders for Life-Sustaining Treatment forms within nursing home settings. Investigators also spoke to a group of 28 residents and their representatives about their knowledge of the forms, and to see how their current treatment preferences lined up with their POLST orders.

Of the residents interviewed, 59% recognized the POLST form. The majority of residents were also accurate in their knowledge of how the forms impact artificial nutrition (79%), antibiotic (74%) and CPR (68%) directives. A smaller percentage of residents (50%) understood the form's provisions on medical interventions.

The POLST forms and residents' own preferences were found to clash for 64% of the residents surveyed in the study. Half of those discordances were fixed through further discussions, researchers noted. The greatest number of discordances (21%) occurred in residents' preferences for antibiotic treatments.

The issue of POLST forms and residents' preferences not aligning is “complex,” researchers said. They called for further interventions that back up the decisions made on the forms and ensure that they match the current preferences of each resident.

Results of the study appear in the Journal of Palliative Medicine.